This second competing renewal application of the Case Western Reserve University (CWRU) AHRQ training program continues to capitalize on Cleveland, Ohio, as a prototypic large North Central American city and on the substantial resources of Ohio's leading research university. Housed in the School of Medicine's Department of Epidemiology and Biostatistics and a vital component of the CWRU-MetroHealth Institute of Public Health Sciences, the AHRQ training program employs established collaborative links in research and training across several CWRU schools and centers that have sustained commitments to advancing knowledge and its application to problems in health services access, equity, cost, and quality. [unreadable] [unreadable] Trainees develop strong methodologic skills while conducting research in a rich array of real world laboratories. With this application, longstanding relationships with Ohio Medicaid and the Ohio Department of Health expand into partnerships in training and research internships; an analogous collaboration is planned with Cleveland's Department of Health. This application also includes new links to community-wide research networks and with the Cleveland Clinic Health System (CCHS), newly a partner in the CWRU community. Strong mentoring is fostered through regular student contact in a weekly health services research seminar and a monthly health services research student lunch. Over the five years of this renewal, the CWRU requests support for 35 positions, including 15 predoctoral and 20 postdoctoral candidates, leading to Ph.D. and M.S. degrees over five and two years, respectively. Requests for predoctoral positions include 10 for exceptional applicants to the CWRU dual-degree (M.D.-Ph.D.) program, inaugurated with CWRU's AHRQ training grant renewal in 1998. Students in the dual-degree program complete their Ph.D. five years after matriculation, and their M.D., seven years after. Expanded demand for our M.S. program has accompanied new institutional relationships (e.g., CCHS) and the demonstrated productivity of trainees, who have used several primary care and condition-specific research networks. Highlighting our program's mission, students focus elective course work and research in one of six areas of concentration, including quality of care measurement and improvement; primary care and prevention; health care decision making and outcomes; disadvantaged populations, access, and equity; health and disability in aging; and health economics and policy. Collectively, our new partnerships and these areas respond to virtually all priorities identified in the request for applications. [unreadable] [unreadable] [unreadable]